Provider Demographics
NPI:1477563484
Name:DOCTORS IMAGING GROUP LLC VASCULAR AND INTERVENTIONAL PHYSICIANS OFFIC
Entity Type:Organization
Organization Name:DOCTORS IMAGING GROUP LLC VASCULAR AND INTERVENTIONAL PHYSICIANS OFFIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PRACTICING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-331-9729
Mailing Address - Street 1:PO BOX 147026
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32614-7026
Mailing Address - Country:US
Mailing Address - Phone:352-331-9729
Mailing Address - Fax:352-331-0136
Practice Address - Street 1:6685 NW 9TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4206
Practice Address - Country:US
Practice Address - Phone:352-333-7847
Practice Address - Fax:352-333-0990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTORS IMAGING GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-09
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270855OtherAVMED GROUP
FLCK3155OtherRRMC GROUP
FL259303304Medicaid
FL45280OtherBC GROUP
FL259303300Medicaid
FLCK3155OtherRRMC GROUP